A maxtopexy augmentation or breast lift with an implant can be a surgery with a built in contradiction. Patients need the lift due to the fact that their native breast tissue and/or skin has weakened with time, resulting in ptosis. The only way to correct any kind of severe droop or sag in the breasts is to lift the skin and tissues back to a higher place on the chest wall. Many of these patients also desire a bit more volume as volume loss is another side effect of the aging process. However, putting a breast implant, particularly a larger implant, into already compromised tissue, even though it’s lifted, can lead to problems down the road.
During his 30 years in practice, Dr. Bruce Van Natta has devoted a lot of time and energy looking for new and better ways to deliver results for his patients. He strives to not just achieve an exemplary result, but also one that will stand the test of time. He began using soft tissue support in his maxtopexy augmentation patients in order to minimize the risk that they might need breast revision surgery at some later date. The goal of this website is to share this knowledge with both patients and his fellow surgeons.
Soft Tissue Support Options
Dr. Van Natta has tried many different types of absorbable scaffolds including:
- Vicryl – multifilament PLGA
- ADM – dermal matrix such as Allerderm & Stratis
- SERI – multifilament silk
- TIGR – combination of multifilament PGLATMC/PLATMC
- Galatea Scaffolds – poly-4-hydrozybuterate (P4HB)
Although he is a huge fan of soft tissue support in general, Dr. Van Natta now exclusively uses the Galatea Scaffolds collection. The reason is P4HB. The ultimate goal of any scaffold or mesh product is to make the patient’s breast tissue stronger. This is what allows the breast to stay lifted and for the implant to remain in position over time. The initial strength of the various absorbable mesh products varies. However, the initial strength is not nearly as important as its strength retention after the healing period. P4HB has both an initial strength that exceeds most of its competitors and it retains 50-70% of this strength 4 months afters surgery. It also provides wound support for up to 52 months. Couple this with the fact that P4HB is:
- easily absorbed by the body
- very low rate of infection
- doesn’t stretch
And it’s clear to see why Dr. Van Natta is such a fan.
Soft Tissue Support Creates Internal Bra of Support
While some patients are born with less than ideal breast tissue, for most, breast tissue weakens with:
- age
- weight gain/loss
- menopause
- pregnancy
- breastfeeding
- hormone fluctuations
- initial breast augmentation with too large of an implant
The end result is sagging, droopy breasts. Creating a strong internal bra of support with an absorbable scaffold will help ensure that the patient’s breasts stay lifted. Furthermore, this support will come from the patient’s own body as it produces more collagen in response to the “injury” of surgery. This collagen weaves in and out of the mesh which eventually dissolves, leaving behind a totally natural, very strong support structure. This is why the mesh can be such a great tool for patients who want a larger implant as it really helps reduce the risk of it eventually falling out of position.
Less Skin Removed with Maxtopexy Augmentation with Mesh
As you can see in this video, Dr. Van Natta has learned that in a maxtopexy augmentation with soft tissue support, it is not necessary to remove as much skin as in a breast lift without mesh. He no longer has to count on the patient’s skin to do all the work. No matter which scaffold that you choose to use, its job is to support the soft tissue. For this reason, he now marks a lot less skin. With soft tissue support, you want to leave patients on the table exactly how you would want to see them long-term. This can be an adjustment at first so he always recommends that with your first 20 cases or so, sit the patient up to make sure that you like the position of her breasts as it is much easier to fix any issues on the table than it is to do so latter.